Overview

Population Characteristics

  • This dataset include 62 confirmed cases admitted from 2018-08-05 to 2019-05-13.

  • 55% girls and 29% children ≤5 years .

  • 20 confirmed deaths reported for an average CFR of 32%.

Stratified Tables

Population characteristics: Children va Adults
Characteristic Adult
N = 3861		 Children (<18)
N = 621		 p-value2
Age at admission – – 0.00
    Median (Min, Max) 33 (18, 71) 10 (0, 17) –
Age Group – – 0.00
    <2 0 (0%) 10 (16%) –
    2-5 0 (0%) 8 (13%) –
    5-12 0 (0%) 20 (32%) –
    12-17 0 (0%) 24 (39%) –
    18+ 386 (100%) 0 (0%) –
Gender – – 0.75
    Male 166 (43%) 28 (45%) –
    Female 220 (57%) 34 (55%) –
Patient occupation – – 0.02
    Healthcare worker 45 (19%) 0 (0%) –
    Non-healthcare worker 111 (47%) 21 (68%) –
    Unknown 78 (33%) 10 (32%) –
Is the patient pregnant? 15 (3.9%) 1 (1.6%) 0.71
Does the patient have any comorbid conditions? 8 (2.1%) 0 (0%) 0.61
Diabetes 1 (0.3%) 0 (0%) 1.00
HIV 3 (0.8%) 0 (0%) 1.00
Chronic pulmonary disease 1 (0.3%) 0 (0%) 1.00
Bleeding 33 (8.5%) 7 (11%) 0.48
Fever 197 (51%) 51 (82%) 0.00
Diarrhoea 142 (37%) 17 (27%) 0.15
Shock 2 (0.5%) 0 (0%) 1.00
Confusion 1 (0.3%) 0 (0%) 1.00
Ebola RDT – – 1.00
    Oraquick 4 (1.3%) 0 (0%) –
    Not done 313 (99%) 49 (100%) –
Admission Delay – – 0.62
    Median (Min, Max) 4.0 (0.0, 34.0) 4.0 (0.0, 39.0) –
Ct (lowest) – – 0.30
    Median (Min, Max) 24 (15, 42) 23 (16, 40) –
Result of GeneXpert PCR – – 0.36
    Positive 322 (99%) 50 (98%) –
    Negative 1 (0.3%) 1 (2.0%) –
    Indeterminate 1 (0.3%) 0 (0%) –
Platelets (x10⁹/L) – – 0.41
    Median (Min, Max) 168 (27, 385) 106 (88, 164) –
Haemoglobin (g/L) – – 0.40
    Median (Min, Max) 13.30 (9.00, 17.90) 12.00 (10.60, 13.80) –
Calcium (mmol/L) US – – 0.57
    Median (Min, Max) 8.20 (4.00, 10.40) 8.50 (7.50, 9.70) –
Hyperkaliemia 5 (1.3%) 2 (3.2%) 0.25
Hypokaliemia 10 (2.6%) 1 (1.6%) 1.00
Renal impairment 41 (11%) 3 (4.8%) 0.16
Rhabdomyolysis 17 (4.4%) 2 (3.2%) 1.00
Severe hypoglycemia 6 (1.6%) 1 (1.6%) 1.00
Oral/orogastric fluids 64 (17%) 13 (21%) 0.40
Antibacterial treatment 326 (84%) 52 (84%) 0.91
Antimalarial treatment 285 (74%) 43 (69%) 0.46
Ebola experimental treatment 170 (44%) 25 (40%) 0.58
Type of Ebola experimental treament – – 0.37
    None 219 (57%) 37 (60%) –
    Remdesivir (GS-5734) 53 (14%) 5 (8.1%) –
    Zmapp 7 (1.8%) 1 (1.6%) –
    mAb114 64 (17%) 15 (24%) –
    REGN3470-3471-3479 43 (11%) 4 (6.5%) –
Outcome at discharge – – 0.48
    Death 126 (33%) 20 (32%) –
    Full recovery with sequelae 1 (0.3%) 0 (0%) –
    Full recovery without sequelae 216 (56%) 31 (50%) –
    Referred to another facility 2 (0.5%) 0 (0%) –
    Unknown 41 (11%) 11 (18%) –
1 n (%)
2 Wilcoxon rank sum test; Fisher’s exact test; Pearson’s Chi-squared test
Population characteristics among Children by Age Group
Characteristic <2
N = 101		 2-5
N = 81		 5-12
N = 201		 12-17
N = 241		 p-value2
Age at admission – – – – 0.00
    Median (Min, Max) 1.0 (0.0, 1.9) 3.0 (2.0, 4.0) 8.0 (5.0, 11.0) 15.0 (12.0, 17.0) –
Gender – – – – 0.15
    Male 6 (60%) 3 (38%) 12 (60%) 7 (29%) –
    Female 4 (40%) 5 (63%) 8 (40%) 17 (71%) –
Patient occupation – – – – 0.45
    Non-healthcare worker 3 (60%) 3 (75%) 10 (83%) 5 (50%) –
    Unknown 2 (40%) 1 (25%) 2 (17%) 5 (50%) –
Is the patient pregnant? 0 (0%) 0 (0%) 0 (0%) 1 (4.2%) 1.00
Bleeding 0 (0%) 2 (25%) 3 (15%) 2 (8.3%) 0.33
Fever 9 (90%) 8 (100%) 15 (75%) 19 (79%) 0.50
Diarrhoea 2 (20%) 1 (13%) 5 (25%) 9 (38%) 0.55
Ebola RDT – – – – –
    Not done 8 (100%) 7 (100%) 16 (100%) 18 (100%) –
Admission Delay – – – – 0.00
    Median (Min, Max) 1 (0, 5) 2 (1, 10) 4 (0, 32) 7 (0, 39) –
Ct (lowest) – – – – 0.25
    Median (Min, Max) 30 (18, 37) 23 (17, 36) 23 (16, 40) 22 (16, 36) –
Result of GeneXpert PCR – – – – 0.33
    Positive 9 (90%) 7 (100%) 17 (100%) 17 (100%) –
    Negative 1 (10%) 0 (0%) 0 (0%) 0 (0%) –
Platelets (x10⁹/L) – – – – 0.22
    Median (Min, Max) -- -- 164 (164, 164) 97 (88, 106) –
Haemoglobin (g/L) – – – – 0.22
    Median (Min, Max) -- -- 10.60 (10.60, 10.60) 12.90 (12.00, 13.80) –
Hyperkaliemia 1 (10%) 0 (0%) 1 (5.0%) 0 (0%) 0.47
Hypokaliemia 0 (0%) 0 (0%) 0 (0%) 1 (4.2%) 1.00
Renal impairment 0 (0%) 0 (0%) 0 (0%) 3 (13%) 0.37
Rhabdomyolysis 0 (0%) 0 (0%) 2 (10%) 0 (0%) 0.27
Severe hypoglycemia 0 (0%) 1 (13%) 0 (0%) 0 (0%) 0.13
Oral/orogastric fluids 3 (30%) 1 (13%) 6 (30%) 3 (13%) 0.41
Antibacterial treatment 9 (90%) 7 (88%) 17 (85%) 19 (79%) 0.92
Antimalarial treatment 8 (80%) 6 (75%) 14 (70%) 15 (63%) 0.80
Ebola experimental treatment 4 (40%) 3 (38%) 8 (40%) 10 (42%) 1.00
Type of Ebola experimental treament – – – – 0.78
    None 6 (60%) 5 (63%) 12 (60%) 14 (58%) –
    Remdesivir (GS-5734) 0 (0%) 0 (0%) 1 (5.0%) 4 (17%) –
    Zmapp 0 (0%) 0 (0%) 0 (0%) 1 (4.2%) –
    mAb114 3 (30%) 2 (25%) 5 (25%) 5 (21%) –
    REGN3470-3471-3479 1 (10%) 1 (13%) 2 (10%) 0 (0%) –
Outcome at discharge – – – – 0.09
    Death 0 (0%) 2 (25%) 6 (30%) 12 (50%) –
    Full recovery without sequelae 6 (60%) 5 (63%) 11 (55%) 9 (38%) –
    Unknown 4 (40%) 1 (13%) 3 (15%) 3 (13%) –
1 n (%)
2 Kruskal-Wallis rank sum test; Fisher’s exact test; NA
Population characteristics among Children by Outcome
Characteristic Deceased
N = 201		 Recovered
N = 311		 p-value2
Age at admission – – 0.01
    Median (Min, Max) 13.5 (3.0, 17.0) 7.0 (0.0, 17.0) –
Age Group – – 0.07
    <2 0 (0%) 6 (19%) –
    2-5 2 (10%) 5 (16%) –
    5-12 6 (30%) 11 (35%) –
    12-17 12 (60%) 9 (29%) –
Gender – – 0.47
    Male 7 (35%) 14 (45%) –
    Female 13 (65%) 17 (55%) –
Patient occupation – – 0.36
    Non-healthcare worker 4 (80%) 9 (53%) –
    Unknown 1 (20%) 8 (47%) –
Is the patient pregnant? 0 (0%) 1 (3.2%) 1.00
Bleeding 4 (20%) 2 (6.5%) 0.19
Fever 17 (85%) 27 (87%) 1.00
Diarrhoea 7 (35%) 7 (23%) 0.33
Ebola RDT – – –
    Not done 17 (100%) 25 (100%) –
Admission Delay – – 0.00
    Median (Min, Max) 7 (1, 39) 2 (0, 32) –
Ct (lowest) – – 0.00
    Median (Min, Max) 19 (16, 29) 27 (19, 40) –
Result of GeneXpert PCR – – 1.00
    Positive 17 (100%) 24 (96%) –
    Negative 0 (0%) 1 (4.0%) –
Platelets (x10⁹/L) – – 0.67
    Median (Min, Max) 135 (106, 164) 88 (88, 88) –
Haemoglobin (g/L) – – 1.00
    Median (Min, Max) 12.20 (10.60, 13.80) 12.00 (12.00, 12.00) –
Hyperkaliemia 1 (5.0%) 1 (3.2%) 1.00
Hypokaliemia 0 (0%) 1 (3.2%) 1.00
Renal impairment 3 (15%) 0 (0%) 0.05
Rhabdomyolysis 2 (10%) 0 (0%) 0.15
Severe hypoglycemia 0 (0%) 1 (3.2%) 1.00
Oral/orogastric fluids 2 (10%) 9 (29%) 0.17
Antibacterial treatment 17 (85%) 26 (84%) 1.00
Antimalarial treatment 13 (65%) 21 (68%) 0.84
Ebola experimental treatment 10 (50%) 10 (32%) 0.21
Type of Ebola experimental treament – – 0.02
    mAb114 3 (15%) 7 (23%) –
    None 10 (50%) 21 (68%) –
    REGN3470-3471-3479 1 (5.0%) 3 (9.7%) –
    Remdesivir (GS-5734) 5 (25%) 0 (0%) –
    Zmapp 1 (5.0%) 0 (0%) –
1 n (%)
2 Wilcoxon rank sum test; Fisher’s exact test; Pearson’s Chi-squared test; NA; Wilcoxon rank sum exact test
  • Eleven participants with unknown outcome at discharge.
Population characteristics among Children by Sex
Characteristic Male
N = 281		 Female
N = 341		 p-value2
Age at admission – – 0.07
    Median (Min, Max) 7.5 (0.0, 17.0) 12.0 (0.0, 17.0) –
Age Group – – 0.15
    <2 6 (21%) 4 (12%) –
    2-5 3 (11%) 5 (15%) –
    5-12 12 (43%) 8 (24%) –
    12-17 7 (25%) 17 (50%) –
Patient occupation – – 0.01
    Non-healthcare worker 13 (93%) 8 (47%) –
    Unknown 1 (7.1%) 9 (53%) –
Is the patient pregnant? 0 (0%) 1 (2.9%) 1.00
Bleeding 2 (7.1%) 5 (15%) 0.44
Fever 21 (75%) 30 (88%) 0.20
Diarrhoea 9 (32%) 8 (24%) 0.45
Ebola RDT – – –
    Not done 22 (100%) 27 (100%) –
Admission Delay – – 0.86
    Median (Min, Max) 4 (0, 28) 4 (0, 39) –
Ct (lowest) – – 0.72
    Median (Min, Max) 24 (16, 40) 23 (16, 40) –
Result of GeneXpert PCR – – 1.00
    Positive 24 (100%) 26 (96%) –
    Negative 0 (0%) 1 (3.7%) –
Platelets (x10⁹/L) – – 0.67
    Median (Min, Max) 164 (164, 164) 97 (88, 106) –
Haemoglobin (g/L) – – 0.67
    Median (Min, Max) 10.60 (10.60, 10.60) 12.90 (12.00, 13.80) –
Hyperkaliemia 2 (7.1%) 0 (0%) 0.20
Hypokaliemia 0 (0%) 1 (2.9%) 1.00
Renal impairment 1 (3.6%) 2 (5.9%) 1.00
Rhabdomyolysis 2 (7.1%) 0 (0%) 0.20
Severe hypoglycemia 0 (0%) 1 (2.9%) 1.00
Oral/orogastric fluids 7 (25%) 6 (18%) 0.48
Antibacterial treatment 24 (86%) 28 (82%) 1.00
Antimalarial treatment 18 (64%) 25 (74%) 0.43
Ebola experimental treatment 9 (32%) 16 (47%) 0.23
Type of Ebola experimental treament – – 0.39
    None 19 (68%) 18 (53%) –
    Remdesivir (GS-5734) 3 (11%) 2 (5.9%) –
    Zmapp 0 (0%) 1 (2.9%) –
    mAb114 4 (14%) 11 (32%) –
    REGN3470-3471-3479 2 (7.1%) 2 (5.9%) –
Outcome at discharge – – 0.34
    Death 7 (25%) 13 (38%) –
    Full recovery without sequelae 14 (50%) 17 (50%) –
    Unknown 7 (25%) 4 (12%) –
1 n (%)
2 Wilcoxon rank sum test; Fisher’s exact test; Pearson’s Chi-squared test; NA; Wilcoxon rank sum exact test

Sampling

Cases Description

Patient Outcomes by Admission Delay

  • Deceased patients had a median admission delay of 7 days (range 1-39)
  • Recovered patients had a median admission delay of 2 days (range 1-5)

Ct kinetics

  • A linear mixed-effects model with random intercepts per participant showed that Ct values significantly increased over time (β = 0.25, p < 0.001), consistent with viral load decline.
  • Participants who died had markedly lower baseline Ct values compared to recovered individuals (β = −8.65, p < 0.001), indicating higher initial viral loads.
  • The interaction between time and outcome was not significant (p = 0.60), suggesting similar Ct kinetics across outcomes.

\[ Ct_{ij} = \beta_0 + \beta_1 (\text{Time from Onset}_{ij}) + \beta_2 (\text{Outcome}_i) + \beta_3 (\text{Time from Onset} \times \text{Outcome}_i) + u_i + \epsilon_{ij} \]

  • (Ct_{ij}): Ct value for participant i at time j
  • (_0): intercept (baseline Ct for recovered)
  • (_1): daily Ct change among recovered
  • (_2): baseline difference (Death vs Recovered)
  • (_3): interaction (difference in Ct trajectory)
  • (u_i): random intercept
  • (_{ij}): residual error

Cases and CFR

Treatments and complications

These complications are inferred from laboratory results :

  • Renal impairment: Creatinine (mg/dL)≥1.1
  • Hyperkaliemia: Potassium (mmol/L)>5.5
  • Hypokaliemia: Potassium (mmol/L)<3.5
  • Rhabdomyolysis: Creatinine kinase (U/L)>1000
  • Severe hypoglycemia: Glucose (mg/dL) <60
  • Severe thrombocytopenia: Platelets (x10⁹/L) <50

Analyses

Approach

flow ImmuneMod Immune modulation DelDirect Deleterious direct effect of virus ImmuneMod->DelDirect +/- ViralLoad Viral load ViralLoad->DelDirect + OrganFail Organ failure DelDirect->OrganFail + Death Death OrganFail->Death + PreExist Pre-existing comorbidity PreExist->OrganFail + Age Age Age->PreExist +/- Sex Sex Sex->PreExist DelayedPres Delayed presentation Sex->DelayedPres Nutrition Nutrition Nutrition->PreExist + DelayedPres->ViralLoad + Vaccination Vaccination Vaccination->ViralLoad - Antiviral Antiviral therapy Antiviral->ViralLoad - Hypoperf Hypoperfusion / shock Hypoperf->OrganFail + Dehydration Dehydration Dehydration->Hypoperf + MetElect Metabolic / electrolyte derangement Dehydration->MetElect + MetElect->OrganFail + Hypoxa Hypoxaemia Hypoxa->OrganFail + Anemia Anaemia Anemia->Hypoxa + SecInf Secondary infection SecInf->OrganFail + SecInf->Hypoxa + Bleeding Bleeding Bleeding->Anemia + ORS ORS ORS->Dehydration - IVfluid IV fluid IVfluid->Dehydration - IVfluid->MetElect - Diarrhoea Diarrhoea Diarrhoea->Dehydration +
  • This Directed Acyclic Graphs (DAG) illustrates hypothesized causal relationships underlying EVD pathophysiology and clinical outcomes.
workflow A 1. Data cleaning and wrangling B 2. Univariate model screening • Identify sparse variables • Exclude predictors causing quasi-complete separation A->B C 3. Collinearity assessment • Variance Inflation Factor (VIF) • GVIF_scaled ≤ 1.68 B->C D 4. LASSO regression • Shrinks weak predictors • Retains strongest associations C->D E 5. Multivariable logistic regression • Include LASSO-selected predictors D->E F OR from multivariable model E->F G Adjusted RR (Poisson) E->G H Raw RR for binary predictors E->H

Ct threshold to predict participant outcome

  • ROC analyses were performed to determine the optimal Ct threshold to predict participant outcome.
  • With an area under the curve (AUC) of 0.87, ROC analyses evaluated the optimal Ct threshold cut-off at 21.35 for predicting patients outcome (sensitivity 79%, specificity 77%).

Independent Predictors of EVD Outcome

  • Multivariable Poisson regression with robust standard errors was used to estimate adjusted risk ratios (aRR) and 95% confidence intervals.
Variable Relative Risk (95% CI) Direction
CT at Admission 0.85 (0.74-0.98) ⬇
Chest Pain 1.85 (0.63-5.4) ↔︎
Desorientation 1.83 (0.76-4.41) ↔︎
Difficulty breathing 1.07 (0.48-2.38) ↔︎
Myalgia / Body Pain 2.02 (1.09-3.71) ⬆
Nausea/Vomiting 1.34 (0.36-4.94) ↔︎

Survival Analyses

  • We used a Weibull proportional hazards model to estimate survival probabilities over time.

  • Forest plot showing relative effects of covariates on survival time estimated from a Weibull proportional hazards model. HR > 1 indicates shorter survival (faster occurrence of the event), HR < 1 indicates longer survival. Error bars represent 95% confidence intervals.

Thank you